5 Home Exercise Strategy

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Belt Assisted Eccentric Curl Backs and Curl Ups

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Retraining, Self-mobilization, Supine Curl Up

Belt Assisted Eccentric Curl Backs and Curl Ups

  • The patient starts in the long sitting position with a belt wrapped around the balls of the feet.
  • Instruct the patient to slowly slump back as though trying to touch their spine to the table segmentally from below up (S1, then L5, L4 etc.).
  • Emphasis is placed on posterior translation at each segmental level.
  • They’re only allowed to roll back as far as they can while maintaining spinal flexion.
  • Once they are able to control segmental flexion eccentrically then they can roll all the way back to the table and then come back up using the belt to assist as needed.
  • Have the patient repeat the exercise 8 to 10 times trying to work a little further back each time.
  • Goal – Eventually the patient should be able to roll all the way back and curl back up with segmental flexion without needing to use a belt to assist and without extending the spine while curling up.

Belt Assisted Eccentric Curl Backs with Therapist Assist

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Retraining, Supine Curl Up

Belt Assisted Eccentric Curl Backs with Therapist Assist

  • The patient starts sitting upright with a belt wrapped around the balls of the feet.
  • The patient is instructed to slowly slump back as though they are trying to touch their spine to the table segmentally from below up (S1, then L5, L4 etc.).
  • The therapist uses manual contacts to the abdominals and also to the spine to bring sensory awareness to specific levels of the spine as the patient proceeds.
  • Emphasis is placed on posterior translation at each segmental level.
  • The patient is only allowed to roll back as far as they can while maintaining spinal flexion.
  • Once they can control segmental flexion eccentrically then they can roll all the way back to the table and then come back up using the belt to assist as needed.

Unilateral Hip Abduction and External Rotation

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Retraining, Supine Hip ABD and ER

Unilateral Hip Abduction and External Rotation

  • The patient is lying on the back, with their thumbs placed above the ASISs to monitor pelvic stability.
  • The patient is instructed to find the midpoint between 12:00 and 6:00 o’clock then draw the belly in towards the spine without flattening the low back so that they maintain a neutral lumbar spine.
  • The patient continues to monitor the position of the ASISs as they slowly drop the right knee out to the side.
  • The patient is instructed that if the R ASIS drops inferiorly when compared to the L ASIS while abducting and externally rotating the R hip they are to return back to the midline and start over.
  • The patient is instructed not to drop the R knee out to the side further than they can maintain leveling at the ASISs.
  • Repeat on both sides for 3-5 repetitions to start, increasing to 10 reps.

Bilateral Hip Abduction and External Rotation with a Neutral Lumbar Spine

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Retraining, Supine Hip ABD and ER

Bilateral Hip Abduction and External Rotation with a Neutral Lumbar Spine

  • The patient is lying on their back and instructed to find neutral, midway between 12:00 and 6:00 while monitoring the ASISs with their thumbs.
  • Instruct the patient to maintain neutral and draw the belly in towards the spine without flattening the low back.
  • While monitoring the ASISs with their thumbs ask the patient to slowly separate the knees while keeping the ASISs still/level.
  • If either ASIS begins to move inferiorly (towards the feet) instruct the patient to stop and bring the knees back to the midline and start over.
  • Repeat 3-5 times
  • The goal is for the patient to be able to maintain a neutral lumbar spine and symmetrically abduct and externally rotate both hips without either ASIS moving inferiorly.

Advanced Transversus Abdominis Retraining (Dead Bugs)

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Lower Quarter, Retraining, Supine Heel slide

Advanced Transversus Abdominis Retraining (Dead Bugs)

  • The patient is lying on their back with both hips flexed to approximately 90º. Ask the patient to find a neutral lumbar spine by having them roll the pelvis from 12 to 6 and find the midpoint.
  • The patient monitors the ASISs with their thumbs to keep them level.
  • Instruct the patient to slowly touch one heel to the table, alternating between the right and left sides while monitoring the ASISs and not allowing an ASIS to drop inferiorly on either side.
  • As their strength improves, they can start extending the hip out further to touch the heel (bottom picture).
  • Have them repeat 3-5 times and increase repetitions as their strength improves.

Advancement of Supine Heel Slide Exercise

in 4 Manual Therapy Strategies, 5 Home Exercise Strategy, All Manual Therapy, Manual Stretching, Retraining

Advancement of Supine Heel Slide Exercise

  • The patient is lying supine with their hips and knees flexed and the feet flat on the table.
  • Instruct the patient to find a neutral lumbar spine position, midway between 12:00 and 6:00, monitoring the ASISs with their thumbs.
  • Have the patient draw their belly in without flattening the low back (the ASISs should not move when they draw the belly in).
  • Instruct the patient to slowly extend their right leg keeping the foot off the table while monitoring the ASISs. The patient tries to touch their heel to the table only after the leg is extended. They then bring the leg back up with the foot remaining off the table. The right ASIS should remain stable as the right leg is extended. If the ASIS moves inferiorly, the patient should stop, and bring the leg back up to the starting position.
  • Goal – the patient should be able to fully straighten either leg without the ASISs moving and touch their heel to the table while maintaining a neutral lumbar spine.
  • They repeat the exercise 3-5 times initially and increase repetitions as their performance improves.

Supine Heel Slides

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Home Exercises, All Lower Quarter, Retraining, Supine Heel slide

Supine Heel Slides

  • The patient is lying supine with their hips and knees flexed and the feet flat on the table.
  • Instruct the patient to find a neutral lumbar spine position, midway between 12:00 and 6:00, monitoring the ASISs with their thumbs.
  • Have the patient draw their belly in without flattening the low back (the ASISs should not move when they draw the belly in).
  • Instruct the patient to slowly slide their right heel along the table while monitoring the ASISs. The right ASIS should remain stable as the right leg is extended. If the ASIS moves inferiorly, the patient should stop, and bring the leg back up to the starting position.
  • Goal – the patient should be able to fully straighten either leg without the ASISs moving while maintaining a neutral lumbar spine.
  • They repeat the exercise 3-5 times initially and increase repetitions as their performance improves.

Transversus Abdominis Retraining

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Lower Quarter, Retraining, Supine Heel slide, Supine Hip ABD and ER

Transversus Abdominis Retraining

  • The patient is lying on their back with the hips and knees flexed and feet flat on the table.
  • Have the patient place their hands on both sides of the lower rib cage.
  • Ask the patient to find a neutral lumbar spine by rolling the pelvis towards 6 and 12 o’clock and finding the midpoint in the range.
  • Instruct the patient to draw the belly in without flattening their lower back maintaining a neutral lumbar spine. The patient monitors the ASISs to make sure that they remain level throughout this exercise.
  • Instruct the patient to slowly inhale through the nose allowing their lungs to fill with air as the rib cage expands out to the sides as they draw the navel in. Their chest and shoulders should remain relaxed and they should not feel that their belly pushes out or that the lower ribs are pulled down and medially by the obliques which can often substitute with transversus abdominis dysfunction.
  • The patient exhales through pursed lips and allows the ribs to fall down and in. Their upper chest should continue to remain relaxed.
  • If they are having difficulty recruiting the transversus have them blow out as much air as possible during exhalation using their abdominal muscles to assist and hold for 3-5 seconds. Then have them slowly inhale while continuing to draw the belly in and hold for 10 seconds.
  • Have them repeat up to 10 times holding for 10 seconds each time.

Diaphragmatic Breathing

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Lower Quarter, Retraining, Supine Heel slide, Supine Hip ABD and ER

Diaphragmatic Breathing

  • The patient is lying on their back with the hips and knees flexed and feet flat on the table.
  • Have the patient place their hands on both sides of the lower rib cage.
  • Instruct the patient to slowly inhale through the nose allowing their lungs to fill with air as the rib cage expands out to the sides as they draw the navel in. Their chest and shoulders should remain relaxed and they should not feel that their belly pushes out or that the lower ribs are pulled down and medially by the obliques which can often substitute for transversus dysfunction.
  • The patient exhales through pursed lips and allows the ribs to fall down and in. Their upper chest should continue to remain relaxed.
  • Have them repeat up to 10 times holding for 10 seconds each time.

Transversus Abdominis Retraining – Advanced

in 2 Movement Tests Lower Quarter, 5 Home Exercise Strategy, All Lower Quarter, Retraining, Supine Heel slide, Supine Hip ABD and ER

Transversus Abdominis Retraining – Advanced

  • Starting in hands and knees with the hips positioned directly over the knees and the shoulders positioned directly over the hands, the patient is instructed to bend their elbows so that the shoulders are the same height as the hips.
  • The patient is instructed to find a neutral lumbar spine by rocking the pelvis from 12:00 to 6:00 and finding the midrange position.
  • The therapist monitors the PSISs to insure that they are level in the frontal plane before starting and during the performance of this exercise.
  • Instruct the patient to draw the belly up and in towards the spine without changing the lumbar neutral position. The therapist monitors the PSISs to insure that they remain stable and provides verbal feedback to the patient if any deviation should occur. The therapist should watch for any loss of the neutral lumbar spine position during the exercise.
  • Ask the patient to lift the left hand off the table and maintain a level pelvis and shoulder girdles.
  • Make sure the patient keeps their right elbow bent, shoulders level and they don’t drop their head when they lift their left hand.
  • Then have the patient switch sides lifting up the right hand.
  • The patient is instructed to hold for 10 seconds on each side as one repetition and repeat 3-5 times, gradually working up to 10 reps.
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